Manchester Pharmacy, School, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom.
Res Social Adm Pharm. 2018 Mar;14(3):241-247. doi: 10.1016/j.sapharm.2017.03.001. Epub 2017 Mar 2.
Doctors at all levels make prescribing errors which can prolong patients' hospital stay, increase the risk of death, and place a significant financial burden on the health system. Doctors have previously reported receiving little or no feedback on their prescribing errors. The effectiveness of feedback in modifying future practice varies widely, depending on how feedback is delivered. To date there is little evidence about why and how feedback interventions do or do not work. Behavioural theories can be used to evaluate this process and provide explanatory accounts to inform recommendations for future interventions.
To explore the experiences of prescribers receiving different methods of feedback about their prescribing errors. Perceptual Control Theory (PCT) was used as a theoretical framework to explain which aspects of feedback were most likely to influence prescribing behaviour.
A secondary analysis of 31 semi-structured qualitative interviews with junior doctors who had taken part one of three studies in which they received feedback on their prescribing errors. A hybrid approach to analysis involved inductive thematic analysis, and deductive a priori template of codes using PCT as a framework to guide data analysis and interpretation.
Feedback was most useful for learning and most likely to influence future prescribing behaviour when it was timely, and provided a comprehensive, contextualised benchmark to which participants could compare their prescribing behaviours and current level of knowledge. Group discussions and completing directly-observed prescribing event forms were thought most likely to impact future prescribing; email feedback alone was perceived as least effective in changing prescribing behaviour.
Feedback has the potential to change future prescribing behaviour. Behaviour change can only take place if prescribers are made aware of these discrepancies, either via providing appropriate reference values or benchmarks before mistakes are made, or by providing timely and comprehensive feedback after mistakes are made.
各级医生都会出现处方错误，这可能会延长患者的住院时间、增加死亡风险，并给医疗系统带来巨大的经济负担。此前有研究报道，医生很少或根本没有收到过关于处方错误的反馈。反馈在改变未来实践方面的效果差异很大，具体取决于反馈的传递方式。迄今为止，关于反馈干预措施为何有效或无效的证据很少。行为理论可用于评估这一过程，并提供解释性说明，为未来的干预措施提供建议。
探讨接受不同方法反馈的处方者对处方错误的体验。使用感知控制理论（PCT）作为理论框架，解释反馈的哪些方面最有可能影响处方行为。
对曾参与三项研究之一的 31 名初级医生进行的 31 次半结构化定性访谈进行二次分析，他们在该研究中收到了处方错误的反馈。混合分析方法包括归纳主题分析，以及使用 PCT 作为框架的演绎先验模板对代码进行分析和解释。
当反馈及时且提供全面、上下文相关的基准时，反馈对于学习最有用，最有可能影响未来的处方行为。参与者可以将自己的处方行为和当前的知识水平与该基准进行比较。小组讨论和完成直接观察的处方事件表格被认为最有可能影响未来的处方；单独的电子邮件反馈被认为最不可能改变处方行为。
反馈有可能改变未来的处方行为。只有当处方者意识到这些差异时，行为改变才有可能发生，要么在犯错之前通过提供适当的参考值或基准，要么在犯错之后提供及时和全面的反馈。
